Preoperative Motor Score Research Articles

Influence of Preoperative Motor Score and Patient Comorbidities on Transcranial Motor-Evoked Potential Acquisition in Intracranial Surgery: A Retrospective Cohort Study.

Intraoperative neurophysiological monitoring plays a pivotal role in modern neurosurgery, aiding in real-time assessment of eloquent neural structures to mitigate iatrogenic neural injury. This study represents the largest retrospective series to date in monitoring corticospinal tract integrity during intracranial surgery with transcranial motor-evoked potentials (TCMEPs), focusing on the influence of demographic factors, comorbidities, and preoperative motor deficits on the reliability of intraoperative neurophysiological monitoring. While the impact of patient-specific factors affecting TCMEP monitoring in spine surgery is well-documented, similar insights for intracranial surgery are lacking. A total of 420 craniotomy patients were retrospectively analyzed from electronic medical records from December 2017 to February 2023, excluding patients without preoperative Medical Research Council scores or medical histories. Using intrinsic hand muscles as a robust data set, 840 hand TCMEPs acquired during intracranial surgery were assessed. Demographic and clinical factors, including preoperative motor scores, were analyzed to identify associations with TCMEP acquisition and amplitude. Nonparametric statistics and multivariate regression analysis were employed. TCMEPs were successfully acquired in 734 (87.7%) patient hands, even in the presence of preoperative motor deficits in 13.9% of total patient hands. Preoperative motor scores did not predict the ability to acquire baseline TCMEPs ( P = .6). Notably, older age ( P < .001) and hypertension ( P = .01) were independent predictors of lower TCMEP acquisition rates. Preoperative motor scores significantly influenced TCMEP amplitudes, with higher scores correlating with higher amplitudes (1771 [SD = 1550] eve vs 882 [SD = 856] μV, P < .0001). Older age ( P < .001) and chronic kidney disease ( P = .04) were also associated with reduced TCMEP amplitudes. Our investigation into TCMEPs during intracranial surgery demonstrated a notably high acquisition rate in hand muscles, irrespective of preoperative motor deficits. Preoperative motor scores reliably correlated with TCMEP amplitudes in a linear fashion while advanced age and renal disease emerged as independent predictors of lower TCMEP amplitudes.

Surgical Outcome of Basal Ganglia Hemorrhage: A Retrospective Analysis of Nearly 3,000 Cases over 10 Years.

Background Basal ganglia hemorrhage (BGH) is a severe neurologic condition associated with significant morbidity and mortality, and its optimal management remains a topic of debate. Our study assessed the surgical outcomes of BGH patients at the 3-month mark using the modified Rankin Scale (mRS). Methods This retrospective observational study was conducted over 10 years at an advanced neuro-specialty hospital in Eastern India, including patients who underwent decompressive craniotomy and hematoma evacuation. Variables were systematically coded and analyzed to evaluate the postoperative outcome with age (in years), preoperative motor (M) status, and hematoma volume. Results This study enrolled 2,989 patients with a mean age of 59.62 (standard deviation: 9.64) years, predominantly males ( n = 2,427; 81.2%). Hypertension (1,612 cases) and diabetes mellitus (1,202 cases) were the most common comorbidities. Common clinical presentations included ipsilateral weakness (1,920 cases) and/or altered mental status (1,670 cases). At the 3-month mark postsurgery, 2,129 cases (71.2%) had a favorable outcome based on mRS, while 389 cases (13.0%) had an unfavorable outcome. The regression equation showed that age was inversely related to the percentage of individuals achieving a favorable outcome. It also revealed that the preoperative motor score was positively correlated with favorable outcomes. Hematomas smaller than 60 mL had better outcomes, with 1,311 cases (69.1%) classified as good outcomes and 337 cases (17.8%) as bad outcomes. Fatal outcomes related to the illness were observed in 471 patients (15.8%) within the study population. Conclusion Surgery for BGH showed a substantial improvement in outcomes, particularly in patients with M5/M4 motor status. The preoperative motor score (M status) emerged as a crucial predictor of favorable neurological outcomes. Age and hematoma volume, however, were found to be nondefinitive factors in determining good outcomes.

193 Expansile Duraplasty Improves Motor Outcomes After Acute Traumatic Spinal Cord Injury

INTRODUCTION: Traumatic spinal cord injury (SCI) can lead to debilitating motor weakness. Early surgical decompression and optimization of spinal cord perfusion have emerged as potential therapies to prevent secondary injury caused by edema, ischemia, and inflammation. Expansile duraplasty extends decompression to the intrathecal space to optimize spinal cord perfusion. There remains a paucity of data on whether this provides a clinical benefit. METHODS: We included patients who underwent decompression and stabilization surgery for traumatic SCI from February 2017 to June 2021 at our level 1 trauma center. In duraplasty patients, a 1.5cm x3.5cm acellular, expansile patch was sutured into the dura at the injury site. We collected demographics, injury type, surgery performed, and American Spinal Injury Association (ASIA) motor scores (range 0-100) pre-operatively and at the time of hospital and inpatient rehabilitation discharge. RESULTS: 101 patients were included: 12 treated with expansile duraplasty and 89 without duraplasty. The mean pre-operative motor score was 48.7 ± 29.3 for all patients, 50.5 ± 19.7 for non-duraplasty and 35.7 ± 23.0 for expansile duraplasty (p = 0.06). At rehabilitation discharge, mean change in motor score from pre-operative exam was significantly higher in duraplasty patients (19.9 ± 11.0 for duraplasty vs. 10.9 ± 13.4 for non-duraplasty, p = 0.02). There were no wound complications in the duraplasty group. CONCLUSIONS: In this single-center, retrospective study, SCI patients undergoing expansile duraplasty had significantly greater improvement in ASIA motor scores at rehabilitation discharge compared to non-duraplasty controls. There was no increase in wound complications nor CNS infection. These data present an independent validation of preliminary data from international centers in favor of expansile duraplasty. Further prospective studies are warranted to assess whether this technique is efficacious in treating acute traumatic SCI.

194. Expansile duraplasty improves motor outcomes after acute traumatic spinal cord injury

<h3>BACKGROUND CONTEXT</h3> Traumatic spinal cord injury (SCI) can lead to debilitating motor weakness with long term impacts on quality of life. Following the initial trauma, secondary injury mechanisms, including edema, ischemia and inflammation can lead to considerable extension of the injury, providing a window of opportunity for interventions to preserve function. Early surgical decompression and optimization of spinal cord perfusion have emerged as potential targets. Expansile duraplasty could provide benefit by extending surgical decompression to the intrathecal space and increasing spinal cord perfusion; however, there remains a paucity of data on whether this provides a measurable benefit. <h3>PURPOSE</h3> Assess whether expansile duraplasty is associated with greater motor recovery in patients with acute traumatic SCI compared with bony decompression alone. <h3>STUDY DESIGN/SETTING</h3> Retrospective review of medical records. <h3>PATIENT SAMPLE</h3> Patients who underwent surgical spinal decompression and stabilization for traumatic spinal cord injury from February 2017 to June 2021 at an academic, Level 1 trauma center. Patients were excluded from analysis if they did not attend inpatient rehabilitation after their acute hospital stay. <h3>OUTCOME MEASURES</h3> Change in American Spinal Injury Association (ASIA) motor scores between preoperative evaluation, acute hospital discharge, and discharge from inpatient rehabilitation. <h3>METHODS</h3> Patients were divided between those who had expansile duraplasty performed at the time of surgical stabilizationand those who did not. Data collected included patient demographics, injury type, surgery performed, and ASIA motor scores (International Standards for Neurological Classification of SCI, range 0-100) preoperatively and at the time of hospital and inpatient rehabilitation discharge. <h3>RESULTS</h3> A total of 101 patients were included: 12 treated with expansile duraplasty and 89 treated without duraplasty. Patients were 76% male with a mean age of 50.9 years. The mean preoperative motor score for all patients was 48.7+/-29.3 (mean +/- std.dev.), 50.5+/-19.7 for the control group and 35.7+/-23.0 for the expansile duraplasty group (p=0.06). From preoperative exam to hospital discharge, the mean improvement in motor score for the control group was 3.7+/-11.3, compared to 9.3+/-11.4 in the expansile duraplasty group (p=0.12). Mean change in motor score from preoperative exam to rehabilitation discharge was 10.9+/-13.4 for controls and 19.9+/-11.0 for expansile duraplasty patients (p=0.02). <h3>CONCLUSIONS</h3> In this contemporaneous, single-center, retrospective study, SCI patients undergoing expansile duraplasty had significantly greater improvement in ASIA motor scores at rehabilitation discharge compared to non-duraplasty controls. These data present an independent and the first US validation of preliminary data from international centers in favor of expansile duraplasty. Further prospective studies are warranted to assess whether this adjunctive surgical technique is efficacious in treating acute traumatic SCI. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Optimized Propofol Anesthesia Increases Power of Subthalamic Neuronal Activity in Patients with Parkinson's Disease Undergoing Deep Brain Stimulation.

IntroductionPropofol is a general anesthetic option for deep brain stimulation (DBS) of the subthalamic nucleus (STN) of patients with Parkinson's disease (PD). However, its effects on STN activity and neuropsychological outcomes are controversial. The optimal propofol anesthesia for asleep DBS is unknown. This study investigated the safety and effectiveness of an optimized propofol anesthesia regimen in asleep DBS.MethodsThis retrospective study enrolled 68 PD patients undergoing bilateral STN-DBS surgery. All patients received local scalp anesthesia, with (asleep group, n = 35) or without (awake group, n = 33) propofol-remifentanil general anesthesia by target-controlled infusion under electroencephalogram monitoring. The primary outcome was subthalamic neuronal spiking characterization during microelectrode recording. The secondary outcomes were clinical outcomes including motor, cognition, mind, sleep, and quality of life at 6 months.ResultsSignificantly increased delta and theta power were obtained under propofol anesthesia (awake vs. asleep group, mean ± standard deviation; delta: 31.97 ± 9.87 vs. 39.77 ± 10.56, p < 0.01; theta: 21.09 ± 5.55 vs. 24.82 ± 6.63, p = 0.01). After excluding the influence of confounding factors of age and preoperative motor scores, there was a statistically significant influence on the delta, theta, and alpha power of STN neuronal activity under different anesthesia regimens (delta: β = 2.64, p < 0.01; theta: β = 2.11, p < 0.01; alpha: β = 1.42, p = 0.01). There were no differences in modified burst index, firing rate, tract numbers of microelectrode recording, and other clinical outcomes between the two groups.ConclusionOptimized propofol anesthesia enhanced the delta, theta, and alpha power in STN compared with the awake technique and likely contributed to target recognition under propofol anesthesia. These results demonstrate that propofol is suitable, but needs to be optimized, for asleep STN-DBS.Trial RegistrationChinese Clinical Trial Registry Identification number: ChiCTR2100045942. Registered 29 April 2021–Retrospectively registeredSupplementary InformationThe online version contains supplementary material available at 10.1007/s40120-021-00259-y.

C5 palsy after cervical laminectomy: natural history in a 10-year series

BACKGROUND CONTEXTC5 palsy is a well-known complication following cervical laminectomy, however the cause of this complication remains elusive, with many studies providing conflicting reports on prognosis and the impact of specific risk factors. PURPOSETo describe the natural history of and risk factors for C5 palsy after first time cervical laminectomy involving C4 and/or C5, in a large series with a high rate of postoperative palsy. STUDY DESIGN/SETTINGThis is a retrospective case series. PATIENT SAMPLEPatients undergoing first time cervical laminectomy for degenerative spine pathologies at a single institution between January 2008 and July 2018. Adult patients were included if a complete laminectomy was performed at C4 or C5 for degenerative pathology and pre- and postoperative upright lateral x-rays were performed. OUTCOME MEASURESThe primary outcome measure was postoperative C5 palsy, defined as a decrease in strength of at least one point in deltoid and/or biceps within 30 days of operation. The secondary outcome measure was recovery of function. METHODSA retrospective database of patients who underwent posterior cervical spine surgery was created and further focused by utilizing specific Common Procedural Technology (CPT) codes associated with our desired patient population. Patients were excluded from our study if they had inadequate pre- and postoperative imaging, as well as patients with a history of prior cervical spine surgery, concurrent anterior surgery, intradural pathology, spinal tumor, or spinal trauma. Patient history, surgical specifics, and neurologic function were recorded. RESULTSA total of 190 patients were treated by 13 surgeons. 53 (27.9%) developed C5 palsy postoperatively. Of patients with C5 palsy, 40 (75.5%) recovered to baseline strength, 46 (86.6%) had at least grade 4 strength at last follow up, and 4 (7.5%) had strength worse than baseline and motor grade less than 4. Median time to recovery was 2.0 (IQR: 0.18 to 8.24) months. Age, gender, preoperative motor score, number of levels decompressed, smoking history, and comorbidities were not associated with a significant increase in the odds of C5 palsy. Risk of C5 palsy increased by 35% for every additional level fused below C4. CONCLUSIONThe risk of C5 palsy is increased with instrumentation caudal to C5 in operations addressing degenerative cervical pathology. This should be taken into consideration during operative planning. Overall prognosis of C5 palsy is good; however, incidence of this condition may be greater than previously reported.

Evaluation of Changes in Preoperative Cortical Excitability by Navigated Transcranial Magnetic Stimulation in Patients With Brain Tumor.

Background: This prospective study aimed to evaluate the cortical excitability (CE) of patients with brain tumors surrounding or directly involving the corticospinal tract (CST) using navigated transcranial magnetic stimulation (nTMS).Methods: We recruited 40 patients with a single brain tumor surrounding or directly involving the CST as well as 82 age- and sex-matched healthy controls. The patients underwent standard nTMS and CE evaluations. Single and paired pulses were applied to the primary motor area (M1) of both affected and unaffected cerebral hemispheres 1 week before surgery. The CE parameters included resting motor threshold (RMT), motor evoked potential (MEP) ratio for 140 and 120% stimulus (MEP 140/120 ratio), short-interval intracortical inhibition (SICI), and intracortical facilitation (ICF). Motor outcome was evaluated on hospital discharge and on 30-day and 90-day postoperative follow-up.Results: In the affected hemispheres of patients, SICI and ICF were significantly higher than in the unaffected hemispheres (p=0.002 and p=0.009, respectively). The 140/120 MEP ratio of patients' unaffected hemispheres was lower than that in controls (p=0.001). Patients with glioblastomas (GBM) had a higher interhemispheric RMT ratio than patients with grade II and III gliomas (p = 0.018). A weak correlation was observed among the RMT ratio and the preoperative motor score (R2 = 0.118, p = 0.017) and the 90-day follow-up (R2 = 0.227, p = 0.016).Conclusion: Using preoperative nTMS, we found that brain hemispheres affected by tumors had abnormal CE and that patients with GBM had a distinct pattern of CE. These findings suggest that tumor biological behavior might play a role in CE changes.

Incidence and degrees of neurologic decline following thoracic costotransversectomy

Background ContextThoracic costotransversectomies (TCT) are amongst the most invasive spine procedures performed. Of greatest concern to the patient and surgeon is the risk of iatrogenic neurologic injury associated with these procedures. Most available studies limit their assessment of neurologic function to nonspecific scales such as the broader ASIA scoring system of A to E and have not comprehensively described the rates of iatrogenic injury following these procedures by looking more precisely with ASIA motor scoring (0–100) which allows for more in-depth analysis. PurposeThe purpose of this study is to investigate the rates and degree of iatrogenic neurologic decline following TCT and subsequent rates and degree of motor recovery. Study Design/SettingRetrospective medical record review at a single institution. Patient SampleAround 116 consecutive patients undergoing TCT operations. Outcome MeasuresNeurological changes from preprocedure to final follow-up assessed by lower extremity motor score. MethodsA retrospective chart review of patients undergoing TCT between May 2008 and April 2018 was carried out. Clinical, surgical, and intraoperative neuromonitoring data were collected. Patients who demonstrated an initial postoperative decline in lower extremity motor scores (LEMS) were followed through their final follow up to assess recovery. ResultsAround 116 patients underwent TCT between T2 and T12 between May 2008 and April 2018. Seven (6.0%) patients demonstrated an immediate postoperative decline as defined by a drop of more than 4 points (mean 15.1; range 5–50) in motor score. All patients who demonstrated an initial postoperative motor score decline returned to within 4 LEMS points of their preoperative LEMS by final follow up. IOMN changes were noted only in half of all monitored patients who were noted to have a decline. ConclusionsIn our series, 6.0% of patients undergoing TCT experienced an initial decline in motor score with 94.0% demonstrating an unchanged or improved examination compared to preoperative exam. In our series, all patients who exhibited a decline recovered to within 4 points of the preoperative motor score within the first year postoperatively.

Digital Measurement of Individual Motor and Proprioceptive Skills in Patients with Osteoarthritis of the Knee Prior to Total Knee Replacement.

In spite of consistent improvement in operative methods for total knee arthroplasty, individual motor deficits may lead to a lower outcome. The preoperative classification in individual motoric capacity may get more significance for the future. Complementary to established questionnaires and clinical tests, this pilot study should demonstrate that it is possible to generate a preoperative motor score using a force platform measurement (KMP). Compared to questionnaires the new score represents digital values suitable for everyday clinical use. In total 63 Patients were randomized selected on the day before a bicondylar total knee replacement. A mobile force platform KMP (Motosana) measured the parameter maximum force, power and balance. Fluctuation area was measured in mm² and fluctuation path in mm. One leg standing without holding, transient help or permanent holding at armrests were registered. The force (Newton) was measured while a modified cross lift exercise and power (Watt) by performing five squads. Based on comprehensive statistical consolidated data of maximum force, power and balance it was possible to create a new motor score "Knie Fit 1.0". Depending on interindividual performance patients were divided into those with higher or lower results. Regarding to their individual motor proprioceptive capacity we could also graduate patients into 4 different groups for force/power and balance. In total 17 of 63 patients offered a complex motor deficit, but on the other hand 17 different patients showed superior results in all categories. It is possible to measure the motor capacity of patients using the mobile force platform (KMP) in everyday clinical practice. Based on this data a new motor score "KnieFit 1.0" was generated and groups of patients with different insufficiencies were created. Further follow-up studies should proof and compare the pre- and postoperative outcome in this field. With "KnieFit 1.0" it may be possible to create an individual perioperative rehabilitation program for compensation of detected deficits.

Clinical Efficacy of Bilateral Deep Brain Stimulation Does Not Change After Implantable Pulse Generator Replacement but the Impedances Do: A Prospective Study

Deep brain stimulation (DBS) is an approved therapy option for movement disorders such as Parkinson's disease (PD), essential Tremor (ET), and dystonia. While current research focuses on rechargeable implantable pulse generators (IPGs), little is known about changes of the motor functions after IPG replacement and the consequences of additionally implanted hardware. To assess changes of the motor functions, the therapy impedances, and the total electric energy delivered (TEED) after elective IPG replacement. We prospectively acquired the data of 47 patients with PD, ET, and dystonia treated with bilateral DBS. Motor functions were rated prior to and after surgery using the revised Unified Parkinson's Disease Rating Scale part III (MDS-UPDRS-III), the Fahn-Tolosa-Marin Tremor-Rating-Scale (FTM-TRS), and the Unified Dystonia Rating Scale (UDRS). Furthermore, the therapy impedances and TEED were assessed at the aforementioned times. While preoperative motor scores were 48.32 ± 17.16 in PD, 39.71 ± 12.28 in ET, and 18.48 ± 16.30 in dystonia patients, postoperative scores were 47.84 ± 24.33, 32.86 ± 15.82, and 15.02 ± 15.17, respectively. Only in dystonia patients, motor scores significantly differed. Perioperative therapy impedance changes were 142.66 ± 105.35 Ω (Kinetra® to Activa® PC), -68.75 ± 43.05 Ω (Activa® PC to Activa® PC), and - 51.38 ± 38.75 Ω (Activa® PC to Activa® RC). Perioperative TEED changes were - 37.15 ± 38.87 μJ, 2.03 ± 35.91 μJ, and 12.39 ± 6.31 μJ in that first, second, and third group, respectively. Both the therapy impedances and TEED significantly differed between groups. Although there were no statistically significant changes in the motor functions of all patients after elective IPG replacement, the therapy impedances were significantly higher and TEED was significantly lower after IPG replacement with concurrent Pocket Adapter implantation.

The application of cortical and subcortical stimulation threshold in identifying the motor pathway and guiding the resection of gliomas in the functional areas

Objective: This study aimed to analyze the application of cortical and subcortical stimulation threshold in identifying the motor pathway and guiding the resection of gliomas in the functional area, and to illustrate the minimal safe threshold by ROC method. Methods: Fifty-seven patients with gliomas in the functional areas were enrolled in the study at Beijing Tiantan Hospital from 2015 to 2017. Anesthesia was maintained intravenously with propofol 10% and remifentanil. Throughout the resection process, cortical or subcortical stimulation threshold was determined along tumor border using monopolar or bipolar electrodes. The motor pathway was identified and protected from resection according to the stimulation threshold and transcranial MEPs. Minimal threshold in each case was recorded. Results: Total resection was achieved in 32 cases(56.1%), sub-total resection in 22 cases(38.6%), and partial resection in 3 cases(5.3%). Pre-operative motor disability was found in 9 cases. Compared with pre-operative motor scores, 19 exhibited impaired motor functions on day 1 after surgery, 5 had quick recovery by day 7 after surgery, and 7 had late recovery by 3 months after surgery. At 3 months, 7 still had impaired motor function. The frequency of intraoperative seizure was 1.8%(1/57). No other side effect was found during electronic monitoring in the operation. The ROC curve revealed that the minimal safe monopolar subcortical threshold was 5.70 mA for strength deterioration on day 1 and day 7 after surgery. Univariate analysis revealed that decreased transcranial MEPs and minimal subcortical threshold ≤5.7 mA were correlated with postoperative strength deterioration. Conclusions: Cortical and subcortical stimulation threshold has its merit in identifying the motor pathway and guiding the resection for tumors within the functional areas. 5.7 mA can be used as the minimal safe threshold to protect the motor pathway from injury.

Iatrogenic Spinal Subarachnoid Hematoma after Diagnostic Lumbar Puncture.

Spinal subarachnoid hematoma (SSH) following diagnostic lumbar puncture is very rare. Generally, SSH is more likely to occur when the patient has coagulopathy or is undergoing anticoagulant therapy. Unlike the usual complications, such as headache, dizziness, and back pain at the needle puncture site, SSH may result in permanent neurologic deficits if not properly treated within a short period of time. An otherwise healthy 43-year-old female with no predisposing factors presented with fever and headache. Diagnostic lumbar puncture was performed under suspicion of acute meningitis. Lumbar magnetic resonance imaging was performed due to hypoesthesia below the level of T10 that rapidly progressed after the lumbar puncture. SSH was diagnosed, and high-dose steroid therapy was started. Her neurological symptoms rapidly deteriorated after 12 hours despite the steroids, necessitating emergent decompressive laminectomy and hematoma removal. The patient’s condition improved after the surgery from a preoperative motor score of 1/5 in the right leg and 4/5 in the left leg to brace-free ambulation (motor grade 5/5) 3-month postoperative. The patient was discharged with no neurologic deficits. Critical complications such as SSH can be fatal. Therefore, a patient undergoing lumbar puncture must be carefully observed. A hematoma that convincingly compresses the spinal cord or cauda equina on imaging results requires early surgical decompression and hematoma removal.

The relevance of age and disease duration for intervention with subthalamic nucleus deep brain stimulation surgery in Parkinson disease

The optimal age and disease duration for consideration of deep brain stimulation (DBS) surgery are not well characterized in patients with Parkinson disease. The aim of this study was to assess variation in motor response to surgery among subgroups stratified by age and disease duration. A total of 46 patients referred for DBS were recruited for the study. Preoperative dyskinesia and rigidity scores were recorded, and then patients received bilateral subthalamic nucleus stimulation. Preoperative motor scores were then compared with postoperative scores over 1 year. At 1 year postoperatively, patients with ≤ 10 years' disease duration showed a significant (45%) reduction in rigidity and a significant (64%) reduction in dyskinesia. Patients with > 10 years disease also showed a significant (70%) reduction in dyskinesia at 1 year postoperatively, but failed to show significant improvement in rigidity (31% reduction). Patients < 70 years old showed a significant (58%) improvement in rigidity and a significant (53%) improvement in dyskinesia. Finally, patients ≥ 70 years old showed a significant (90%) improvement in dyskinesia, but failed to show any significant change in rigidity at 1 year postoperatively. The postoperative improvement in rigidity for younger patients with shorter disease duration may indicate that performing early surgery maximizes the benefit of DBS. However, older patients with primarily dyskinesia symptoms also appear to have significant clinical improvement, and DBS can offer relief from this common consequence of long-term levodopa use.

Clinical and economic results of bilateral subthalamic nucleus stimulation in Parkinson’s disease

Background: High frequency stimulation of the subthalamic nucleus (STN) is an alternative but expensive neurosurgical treatment for parkinsonian patients with levodopa induced motor complications. Objective: To assess the safety, clinical...

Perioperative complications with costotransversectomy and anterior approaches to thoracic and thoracolumbar tumors

Anterior decompression and stabilization for thoracic spinal tumors often involves a thoracotomy and can be associated with surgical approach-related complications. An alternative to thoracotomy is surgery via a costotransversectomy exposure. To delineate the risks of surgery, the authors reviewed their prospective database for patients who had undergone surgery via either of these approaches for thoracic or thoracolumbar tumors. The complications were recorded and graded based on severity and risk of impact on patient outcome. Between September 1995 and April 2001, the authors performed 29 costotransversectomies (Group 1) and 18 thoracolumbar or combined (Group 2) approaches as initial operations for thoracic neoplasms. The age, sex, preoperative motor score, and preoperative Frankel grade did not significantly differ between the groups. In the costotransversectomy group there were greater numbers of metastases, upper thoracic procedures, and affected vertebral levels; additionally, the comorbidity rate based on Charlson score, was higher. The mean Frankel grades at discharge were not significantly different whereas the discharge motor and last follow-up motor scores were better in Group 2. There were 11 Group 1 and seven Group 2 patients who suffered at least one complication. The number or patients with complications, the mean number of complications, and severity of complications did not differ between the groups. Compared with anterior or combined approaches, the incidence and severity of perioperative complications in the surgical treatment of thoracic and thoracolumbar spinal tumors is similar in patients who undergo costotransversectomy. Costotransversectomy may be the preferred operation in patients with significant medical comorbidity or tumors involving more than one thoracic vertebra.

Sexual dysfunction in men with paraparesis in lumbar burst fractures.

A retrospective follow-up study. To review and analyze the sexual function of patients who have sustained lumbar fractures with incomplete paraparesis. As a result of advances in surgical techniques, most patients with lumbar fractures have significant recovery of neurologic status. Because motor functions are important to patients, most of the studies have concentrated their analyses on motor recovery. Many patients who have almost completely recovered motor function, however, may have sexual dysfunction, especially men. Forty-three patients with lumbar fractures that resulted in incomplete paraparesis were analyzed. American Spinal Injury Association motor index points were determined for each patient before and after surgery and used for comparison between American Spinal Injury Association motor index and international index of erectile function score. Eleven male patients who reported sexual dysfunction were evaluated by using Rigiscan. During the follow-up period, 42 patients showed neurologic recovery. Average improvement of American Spinal Injury Association motor score was 13. 1 and average international index of erectile function score was 45. Average improvement of American Spinal Injury Association motor score for patients who had not reported sexual dysfunction was 12.5, and average international index of erectile function score was 52. For 11 patients in the sexual dysfunction group, preoperative motor score was 28.0, and average improvement of score was 14.9. Nocturnal penile tumescence monitoring results were abnormal in four cases. Averaged international index of erectile function score was 15. There was a statistically significant difference between the sexually healthy and dysfunctional groups in international index of erectile function score (P < 0.05), whereas no difference was noted in American Spinal Injury Association motor score. Neurologic recovery after lumbar fractures was improved. Regardless of neurologic recovery, most patients reported some disability, usually caused by pain and occasionally sexual dysfunction. Impairment of sexual function was present in four patients (9.3%). Although these patients may preserve psychiatric erection potential, they usually experienced sexual problems.